Reimbursement Matters: 2027 Medicare Rules & Evolving Coverage Issues

I think one of the most, uh, pressing things that's, uh, that we've been talking about over the last, uh, month or two is the 2027, uh, Medicare proposed rules, uh, both within the, uh, PFS and within, uh, the, the HOPPS.

Um, so Terri, if you could just give a brief summary, a overview of kind of the process of how these proposed rules work, um, and, uh, and then we can get into what, uh, the changes might be that, that are coming, uh, in these proposed rules.

Yeah.

Sure.

Uh, so every year, usually around the Fourth of July holiday, maybe about a week or so later, Medicare will propose the rules, and there's a separate one for the Medicare physician fee schedule.

So even as a physician who works in a hospital setting, if they're employed by the hospital or, or an office setting, they're gonna follow one set of rules.

And then there's the hospital patient respective payment system.

So two different rules that come out.

Um, and then we as societies, as, as, as entities, have 60 days to comment.

So we can submit our comments to Medicare with whether we agree, disagree with what they're proposing, and then usually around, uh, November 1st is when we're looking to see what do they finalize for next year.

So then we have the 60 days to kind of get ready for what's happening for 2027.

And, uh, the hospital patient rules came out first the beginning of July, and then the Medicare physician fee schedule was a little bit delayed, but the comments have been submitted now to Medicare by ACRO, uh, and what their responses were.

Yeah.

So th- thanks for that overview.

I guess could you talk a little bit about what were some of the big proposed changes affecting radiation oncology?

Yeah.

Luckily...

I mean, overall luckily we didn't have anything very, that was really targeted to radiation oncology.

You know, we had our new code updates this year for the external beam codes, the 77402, 407 and 412, and then we've also had the superficial, uh, the surface radiation therapy codes.

So there was...

I, I think it's still kind of figuring out our footing with some of that, um, and how Medicare's really valued the codes, and I think that's really been the big focus, uh, especially for ACRO and the GREC when they were putting those comments together to Medicare and kind of looking at how they valued them.

Because normally what's the hospital's paid and what the, the office is paid, it's, it's valued very differently.

But what they've done is they've tied them together.

And so as a physician, if you own your own practice as an office or a freestanding center, it- you do want, you do care what happens in the hospital and how they value those codes.

And so, uh, what ACRO really focused on was really kind of...